1997 Partnerships for Networked Consumer Health Information Conference

Transcripts of Plenary Sessions and Breakout Sessions

"Customizing Information 4: Global Health Connections"

Wednesday, April 16, 1997
9:30-11:00 AM

Moderator: Roberto Rodrigues, M.D., Program Coordinator, Health Services Information Systems, The Pan American Health Organization, Washington, DC

Salah H. Mandil, Ph.D., Director of Informatics, The World Health Organization, Geneva, Switzerland

Eugene Boostrom, M.D., Dr.P.H., Senior Public Health Specialist, Economic Development Institute, Human Resources and Poverty Division, The World Bank, Washington, DC

Warren B. Buhler, Consultant, InterAmerican Development Bank, Washington, DC

Rodrigues: I will address a demand for access to biomedical knowledge and examine deterrents to reforming existing systems. They are:

1. the state's ability to maintain social benefits and health care systems;
2. social and political changes; and
3. the requisite new vision of the social role of the state.

There are major infrastructure issues that have remained unresolved in Latin America. They include the need to access computer technology, availability of telecommunications in health care, improved telecommunications availability, quality and cost issues, a monopolistic national telecom structure, computer literacy, and general education level.

There are many issues regarding the appropriateness of information technology as well, such as bandwidth. Bandwidth capabilities range from very low technology to very high technology. Another concern is utilization. The key findings are that over one-quarter of rural hospitals now have telemedicine services--but two-thirds of these have teleradiology only. We do not want to implement these limited systems.

The multiple stakeholders issues are technology, providers and regulators, services and "solutions," providers, users, diversity of goals and roles, and a very important meeting on telecommunications in health care.

We talked about problems in the region. We wanted to know how the technology could be used to improve health care. We must have prerequisites before deploying telehealth applications.

Issues and trends include a general recognition that telehealth and telecommunications in health care are beneficial. Also to be considered are critical constraints; rising health care costs; reimbursement for services; and that concentration is in few specialized centers. Telehealth also allows for uncontrolled alternative health practices. Ethical and legal aspects; licensing and transfrontier practice; different national telecom regulations and standards; and the need for open solutions need to be addressed. Strategies for action include creating a framework and infrastructure; finding appropriate information products and services; market institutionalization; and leadership.

Shared standards are a major problem. Recommended actions are to evaluate infrastructure on a country-by-country basis; share information; evaluate costs and benefits; prioritize projects and programs; and to implement a stepwise process.

Buhler: We are looking at the information infrastructure and we are looking at the policy reform that is necessary. The InterAmerican Development Bank is moving further on this. That's because the private sector is selling to the private sector. To pull this program together, we have gone to various parts of the country and have assigned leaders to identify what it is that should be happening there. We have joined these leaders with a lot of people to inform them about developments and how the industry can work to get projects moving. The task force in health care has met already. We have started a team of people from various places that is working with [Rodrigues] in developing an overall program.

Standards to guide this program development would make it a whole lot cheaper. We are looking to develop packages that would be affordable and useable in the Latin American market. We are trying to develop a regional program. We have people who are leading these efforts in their own countries. Each country has a different set of circumstances that needs to be addressed. These programs will be presented in Mexico on July 14 and 15.

We have put up a web site that has the health task force on it. But it is an in-house effort at this point. We will have a large meeting in September to deal with affordability. Most of the infrastructure cannot be useful if it is just for the health care community. You have very limited access to the Net.

One of the things we are looking at is community development centers. We have come up with ideas such as that every hospital should have a community training center. We are looking at the distribution paradigms. One final point is that, when you are trying to find a way to help the region, telemarketing can be instrumental, but it is a tremendous computer cost. We are looking at the infrastructure at various levels--low end and high end.

Boostrom: We need to work with countries that will promote equity, which is something that does not happen automatically. We need to work with the projects that we have. We must concentrate on our staff and how we deploy people as we move forward. Now we are trying to divide sectoral networks. We go across all the regions and link them up. The Bank is looking at cross-sectors, and we are trying to work with our staff and other partners, donors and supporters. In Africa, there is a push to increase network capability. But this effort will not be effective if we do not improve some other basic things. There are standards in terms of data- and format-structured databases that need to be developed, and the Internet needs to be used. We do not need to just push information out, but we need to get it back from other countries. For example, we need feedback to help us determine how we utilize the sytem for the surveillance of disease. Strategies to accomplish all of these priorities are being coordinated by different regions. One suggestion is to make general information available to people who cannot afford to pay for the journals by putting it on the network. We need to work on the quality of information and the access to information.

Mandil: We have been very focused at Marshall Legacy Institute. We are coming up on the 50th anniversary in June 1997. They did not want to use this occasion just to be commemorated, -- they also wanted to examine development of a national information system. We are trying to build the infrastructure and rejoin it with other Nations. Is it possible to take the concept of information infrastructure and move forward with the power of knowledge? What we are trying to do is complete the legacy of George Marshall. We are trying to increase markets and security for economic growth. The Marshall Plan was a stove pipe Government-funded program. The vision is to have a new transformation through the invigoration of global health care delivery. This is to be achieved by leveraging the power of the information age, through economic growth, greater global interdependence, and well being.

We have to bring together interested parties (private interests, governments, non-governmental agencies, commercial interests); demonstrate the vision; learn; and foster innovation and growth. We need to learn from what happens. So again the key is building this network. Can we build a small group to tie together these venues? Marshall gave us his vision, which was enough to withstand the Cold War. Our framework is to eat this elephant one bite at a time. One of the challenges in the health arena is taking information technology and addressing the issue. One method that may be used is a mine injury database. How can we improve access to knowledge? How can we improve dollar appropriation? What are the costs of not fully using today's technology? How can we improve health to address these issues? Marshall has worked toward these improvements by striving to complete the legacy of Marshall in the 21st Century. We see our role as serving as a catalyst to improve access to knowledge, thus accomplishing stability, growth, and prosperity. Thank you.

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